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Int J Infect Dis. 2017 Jun;59:96-102. doi: 10.1016/j.ijid.2017.04.017. Epub 2017 Apr 27.

Utility of urine lipoarabinomannan (LAM) in diagnosing tuberculosis and predicting mortality with and without HIV: prospective TB cohort from the Thailand Big City TB Research Network.

Author information

1
Department of Medicine, Faculty of Medicine, Chulalongkorn University, The King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand. Electronic address: oatawa006@gmail.com.
2
Department of Medicine, Faculty of Medicine, Chulalongkorn University, The King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand.
3
Department of Medicine, Bamrasnaradura Infectious Diseases Institute (BIDI), 26, Mueang Nonthaburi District, Nonthaburi 11000, Thailand.
4
HIV-NAT, The Thai Red Cross AIDS Research Centre (TRC-ARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand.
5
Rajavithi Hospital, 2, Phayathai Road, Ratchathewi District, Bangkok 10400, Thailand.
6
Department of Medicine, Faculty of Medicine, Chulalongkorn University, The King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand; HIV-NAT, The Thai Red Cross AIDS Research Centre (TRC-ARC), 104 Ratchadamri Rd, Pathumwan, Bangkok 10330, Thailand.

Abstract

OBJECTIVES:

To evaluate the applicability and accuracy of the urine lipoarabinomannan (LAM) test in tuberculosis (TB)/HIV co-infected patients and HIV-negative patients with disseminated TB.

METHODS:

Frozen urine samples obtained at baseline from patients in the TB research cohort with proven culture-positive TB were selected for blinded urine LAM testing. One hundred and nine patients were categorized into four groups: (1) HIV-positive patients with TB; (2) HIV-negative patients with disseminated TB; (3) HIV-negative immunocompromised patients with TB; and (4) patients with diseases other than TB. The sensitivity of urine LAM testing for culture-positive TB, specificity of urine LAM testing for patients without TB, positive predictive value (PPV), and negative predictive value (NPV) were assessed.

RESULTS:

The sensitivity of the urine LAM test in group 1 patients with a CD4 T-cell count of >100, ≤100, and ≤50 cells/mm3 was 38.5%, 40.6%, and 45%, respectively. The specificity and PPV of the urine LAM test were >80%. The sensitivity of the test was 20% in group 2 and 12.5% in group 3, and the specificity and PPV were 100% for both groups. A positive urine LAM test result was significantly associated with death.

CONCLUSIONS:

This promising diagnostic tool could increase the yield of TB diagnosis and may predict the mortality rate of TB infection, particularly in TB/HIV co-infected patients.

KEYWORDS:

Acid-fast bacilli (AFB); Disseminated tuberculosis; HIV-infected patients; Tuberculosis; Urine lipoarabinomannan

PMID:
28457751
DOI:
10.1016/j.ijid.2017.04.017
[Indexed for MEDLINE]
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